Children are often referred to occupational therapy for handwriting difficulties, especially within the educational model. Yet, you’ll rarely see me doing handwriting within one of my sessions. And this often baffles the minds of the parents and teachers who have brought their child/student to me.
The reason is, as an occupational therapy practitioner, I’ve been trained to look at the whole person and to figure out what underlying skills are needed for tasks like handwriting. I consider handwriting to be a very high-level skill and though some children are able to figure out ways around the roadblocks and succeed with handwriting even with foundational skills missing, it could be even easeir for them if their foundaiton was stronger.
What is needed to be successful at handwriting?
First, I look at the child’s ability to process sensory stimuli and self-regulate. If a child is unable to sit still, be able to listen to the most important information in a sea of auditory stimuli, and not be distracted by visual stimuli they are going to struggle learning. If they struggle with knowing where there body is in space and how they relate to their seat and desk, they’re going to be fidgeting, falling out of their seat, or slouching. If they can’t feel the amount of pressure they are holding a pencil with they will either exert too much pressure and have hand pains or be constantly dropping their pencil.
Next I look at their primitive reflexes. If they have unintegrated reflexes in their hands, they most likely won’t have an appropriate grasp. Spinal reflexes often make it difficult to sit still in a chair as every time their spine touches the back of the chair they’ll involuntarily “wiggle” and those reflexes are often tied in with attention deficits. I’ll look at their ATNR and their STNR as these can effect their posture and how the different parts of their body work together.
Then, I’ll look at their muscle tone. How is their core? Are they able to sit upright in a chair? Are their shoulders, arms, and hands all strong enough to participate in handwriting?
Then there is bilateral coordination- the ability to use both sides of the body at the same time. Such as holding the paper with one hand and writing with the other. Motor planning? Are they able to motor plan big gross motor movements? Generally these movements need to be mastered before children can master the movements our smaller muscles do. Then we can work on the motor planning needed for in-hand manipulation, finger isolation, hand-arch development, and so forth.
And then there is vision work. Can a child’s eyes converge? If not, he’s going to struggle looking at the board and then looking at his paper to write. Can he track? If not he’s going to struggle reading and keeping his place while writing. What about visual perception skills? Things such as visual closure, figure-ground, visual memory, form constancy, visual discrimination, and spatial relations all are so important for children to know which way letters go, how to space, where they go in relation to lines, and so forth.
I could go on and on and on. This isn’t even a definitive list of all the components or foundational skills needed for a child to truly succeed at his very best with handwriting.
When you observe your child or student in OT, that you thought was only there for handwriting, and see them lying on the ground making snow angels, playing in shaving cream, doing army crawls across the floor, throwing a ball back and forth, log rolling, or playing with play-doh…be assured, they are in fact, working on handwriting. And ask! Us occupational therapy practitioners absolutely love to share the “why’s” of what we are doing!